I have heard voices since I was a child. I used to think everyone did, until I got older and realised something was wrong. I’ve been in hospital more times than I can remember, and I’ve been sectioned on four occasions. I don’t remember some of the admissions. Perhaps moments of them, but then it feels like looking at a photograph of yourself and not remembering how it came to be taken.
I always remember when people were nice to me, though. Daft things, really. When someone lent me their phone charger or gave me their chair in the day room, because they knew I liked to sit next to the window. Nurses who listened to me. Doctors who cared. I hold on to those moments when I’m ill, because when your life is filled with bad things, you have to keep polishing the little pieces of good just to keep you going.
The patient
On my first day in psychiatry, after we had done the patient reviews and gone through the drug charts, and I had typed up the discharge letters, I asked how I should spend my afternoon.
I was still smarting from my experience in general medicine and was determined to show I could be a good doctor. I wanted to make a decent impression, to give this job the best shot I could before I admitted defeat; before I finally threw in the towel for good.
After a brief pause, I was told I should talk to the patients.
I had just spent a year being told that I talked to the patients too much.
The relief was unimaginable.
Of all the underfunding in the NHS, it is most noticeable by far in mental health services. Perhaps that’s because here you often find people who have nothing to begin with. While patients I had met before usually had a framework of people they could rely on – to make sure they took their medication, to do a bit of shopping for them until they were back on their feet, to stand their corner, or just talk to them – there were mental health patients, thanks to a life spent largely being ignored and excluded, who had no one. Not a soul. I met one woman with schizophrenia who said that she’d stopped taking her medication because it took away the voices she heard, and they were the only ones keeping her company.
When the embroidery of life is taken away, when those who support and bolster and underpin are removed from our picture, and we are standing completely alone, only then does the true effect of isolation become apparent, and the NHS is left to deal with the consequences of those losses. The small spaces where people used to find comfort and companionship. The libraries. The coffee clubs, the inner-city projects and the village halls, all cut away and vanished, leaving whole armies of people with nowhere to go. Without these spaces, communities themselves eventually fragment and disintegrate. Whereas once we would notice if someone in our neighbourhood was struggling and unable to cope, now roads and avenues unfold endlessly across a landscape and houses are filled with people we neither meet nor care about.
‘Nobody on my street knows my name,’ said one patient. ‘No one would even notice if I disappeared.’
Some of the patients on a mental health ward have spent their lives drifting unanchored, existing alongside serious illness without support or even acknowledgement, until one day that serious illness causes them to catch and snag on a corner of society, and the rest of the world becomes aware of it. Sometimes, the catch is small and manageable. Sometimes, it is not. Sometimes, the unmanageable is caught just in time, like the accountant who stood on a train platform and heard the voice of God telling him to push a stranger on to the tracks.
‘I wanted him to die because he’s part of The Club,’ the accountant said. ‘They’re after me. They’re everywhere.’
His eyes pleaded for something and his voice carried with it a question, and I wasn’t certain if that question was a need for acknowledgement or a need for a release from the person his illness had forced him to become.
Sometimes the unmanageable isn’t caught in time and this is when we see hysteria and screaming headlines, as society forgets that the patient and the illness are not as one, and we blame the person when we really should be blaming our own failure to notice when that person is first in need of help.
Others on mental health wards seem to arrive from nowhere, from quiet, anchored lives, from suburban houses on leafy streets where you wouldn’t imagine mental illness would wander at all. The first thing you will notice as you walk on to the ward is a gathering of people from all backgrounds and from all circumstances. There are those without homes or jobs, and those with families and professions. Those who have lived with mental illness their whole lives and whose notes span several volumes, and those who find that one day they are suddenly no longer able to cope with whatever life has delivered to them. It is also fair to say that on every mental health ward and in every psychiatry outpatient clinic, you will find a huge army of midwives, doctors, nurses, pharmacists and social workers. You will find the NHS, stretched to its very limits.
The second thing you will notice as you walk on to the ward is that all those people, and all their variety of backgrounds, have become a community. There is often tension and argument, and the dynamic changes with each new admission, but similarities are celebrated and differences are forgotten. Patients support each other. Friendships are made. Perhaps thrown together by chance and circumstance, unity is built out of diversity and the ward supplies what society has so often failed to provide – a sense of belonging.
I could feel it as soon as I arrived on my first day, as soon as I pushed open the double doors and walked on to the ward, and I knew instantly it would provide the very same thing for me too.
So many nurses are extraordinary, but I have never met more extraordinary nurses than I did in mental health.
Not just the nurses, either. The support workers, the occupational therapists, the social workers and the volunteers. The doctors, the ward managers, the pharmacists, and the speech and language therapists. An entire population of people whose only purpose in life is to give a patient back their self-belief, and to rescue a life worth living. So many times, I saw small moments of compassion – so fleeting, so transient, they could easily have gone unnoticed. If I told them here, they would seem insignificant and they would be lessened by the telling, but to watch them across a ward or a day room took my breath away. Because those moments reminded me of the kindness one human being can show to another, to a stranger. This kindness is nothing to do with wearing a uniform or holding a stethoscope. It’s to do with being human, and in psychiatry, I began to witness the very best of humanity.